Cephalalgia最新文献

{"title":"OnabotulinumtoxinA for the preventive treatment of episodic migraine: Results from the phase 3, multicenter randomized, double-blind, placebo-controlled phase of the PRECLUDE trial.","authors":"Patricia Pozo-Rosich, Andrew M Blumenfeld, Richard B Lipton, Ronald E DeGryse, Beibei Li, Aubrey M Adams, Thu Nguyen, Lynn James, Mitchell F Brin","doi":"10.1177/03331024251370769","DOIUrl":"https://doi.org/10.1177/03331024251370769","url":null,"abstract":"<p><p>BackgroundMigraine is a complex disabling neurological disease characterized by recurrent headache attacks lasting 4-72 h with moderate to severe intensity and other accompanying symptoms. While chronic migraine (CM) and episodic migraine (EM) are primarily differentiated by the frequency of headache and migraine days, underlying clinical and functional differences have been described. OnabotulinumtoxinA (onabotA) has been approved as a preventive treatment for CM with controlled clinical and real-world evidence suggesting potential benefits for treatment of EM. Given the lack of randomized controlled trial data, PRECLUDE, a prospective phase 3 trial was designed to evaluate the efficacy and safety of onabotA for the preventive treatment of EM.MethodsThe PRECLUDE trial was a phase 3 multicenter, randomized, double-blind, placebo-controlled, parallel-group trial with an open-label onabotA 195 U extension phase. In total, 775 patients aged 18-65 years with a history of migraine attacks were randomized (1:1:1) to receive placebo, onabotA 155 U, or onabotA 195 U. Patients recorded daily headache data and medication use via an electronic diary (eDiary) during a four-week screening phase, 24-week double-blind phase, followed by a 24-week open-label extension phase. The primary endpoint was the change in the frequency of monthly migraine days from baseline across months 5 and 6.ResultsAll treatment groups showed a reduction in the frequency of monthly migraine days from baseline; however, neither the onabotA 155 U group nor the 195 U group demonstrated a statistically significant improvement compared to the placebo group (<i>p</i> >0 .05). Similarly, secondary endpoints, including changes in monthly headache days, 50% responder rates and monthly acute medication use days, did not reach statistical significance. Adverse events in this trial were consistent with previous findings for onabotA in CM and were generally mild to moderate in severity.ConclusionsThe PRECLUDE trial demonstrated that onabotA was well tolerated but did not show significant efficacy compared to placebo for the endpoint reducing migraine days from baseline in patients with EM as defined by the trial protocol. While onabotA is effective for CM, these findings highlight the need for further research to better understand the pathophysiological differences between EM and CM and to understand whether there is a potential subset of EM patients which respond to onabotA.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251370769"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts from the 22^nd International Headache Congress, 11-13 September 2025, São Paulo, Brazil.","authors":"","doi":"10.1177/03331024251366059","DOIUrl":"https://doi.org/10.1177/03331024251366059","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 1_suppl","pages":"3331024251366059"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical musculoskeletal dysfunctions in pediatric migraine: A cross-sectional study.","authors":"Nathiely Viana da Silva, Débora Bevilaqua-Grossi, Juliana Pradela, Fabiola Dach, Carina Ferreira Pinheiro-Araujo","doi":"10.1177/03331024251387033","DOIUrl":"https://doi.org/10.1177/03331024251387033","url":null,"abstract":"<p><p>BackgroundWhile the association between migraine, neck pain, and cervical musculoskeletal dysfunctions is well established in adults, such a relationship remains unclear in the pediatric population. This gap limits our understanding of early pathophysiological mechanisms and hinders the development of targeted interventions.ObjectiveTo assess self-reported neck pain, pressure pain threshold (PPT), global cervical range of motion (ROM), and upper cervical mobility in children and adolescents with and without migraine.MethodsA cross-sectional study was conducted with 102 participants in total (51 with migraine - MG - and 51 controls - CG), aged six to 16 years. Neck pain characteristics (presence, frequency, intensity, and duration) were recorded. Cervical ROM was measured in flexion, extension, lateral flexion, and rotation. Upper cervical mobility was evaluated using the Flexion Rotation Test (FRT), and PPT was bilaterally assessed in the sternocleidomastoid, levator scapulae, suboccipital, upper trapezius, and anterior scalene muscles. Comparisons between groups were made using Student's t-test, Mann-Whitney U test, or Chi-square test, with a significance level set at 5%.ResultsCompared to the control group, the MG showed a higher prevalence of neck pain (39.2% vs. 5.9%; p < 0.001) and longer average duration (19 ± 8.6 vs. 8 ± 3.4 h; p = 0.046). Reduced lateral flexion (p < 0.001) and reduced upper cervical mobility (p < 0.001) were observed in the MG. Additionally, all evaluated muscles exhibited significantly lower PPT values in the MG (p < 0.001) than controls, indicating increased pain sensitivity.ConclusionSimilar to adults, children and adolescents with migraine demonstrate cervical musculoskeletal impairments, including neck pain, reduced cervical mobility-especially in lateral flexion and upper cervical rotation-and heightened sensitivity in craniocervical muscles. These findings support the routine inclusion of cervical musculoskeletal assessments in the clinical management of pediatric migraine.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251387033"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary, but not equivalent: Clarifying the role of RWE and RCT in migraine research.","authors":"Mario F P Peres, Hsiangkuo Yuan, Cristina Tassorelli","doi":"10.1177/03331024251381333","DOIUrl":"https://doi.org/10.1177/03331024251381333","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251381333"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunctive occipital nerve block for emergency treatment of acute migraine: A randomized, controlled trial.","authors":"Cesar David Tamayo de Leon, Elliot Gabriel Gama-Reyes, Felipe Alejandro Paredes Moreno, Javier Andres Galnares-Olalde","doi":"10.1177/03331024251381764","DOIUrl":"https://doi.org/10.1177/03331024251381764","url":null,"abstract":"<p><p>AimTo evaluate the efficacy and safety of greater occipital nerve (GON) block combined with triple therapy versus triple therapy alone in the treatment of acute migraine in the emergency department for severe or refractory cases setting.MethodsWe conducted a prospective, randomized, controlled trial without use of placebo control in adult patients with migraine according to International Classification of Headache Disorders, 3rd editon criteria. Patients were randomly assigned (1:1), without blinding method, to receive either a GON block (methylprednisolone 80 mg + lidocaine 20 mg) plus triple intravenous therapy (ketorolac, paracetamol, metoclopramide) or triple therapy alone. The primary outcome was the proportion of patients achieving ≥50% reduction in headache intensity on a visual analog scale (VAS) two hours post-treatment. Secondary outcomes included changes in monthly migraine days, pain-free days, Headache Impact Test-6 (HIT-6) scores and hospital readmissions at 30-day follow-up.ResultsForty-two patients were enrolled (21 per group). A ≥50% VAS reduction at two hours occurred in 95.2% of patients receiving the GON block versus 47.6% in the control group (<i>p</i> = 0.0003). Median pain reduction was 6.0 vs. 3.0 points, respectively (<i>p</i> < 0.001). At 30 days, the intervention group reported fewer migraine days (median 3.0 vs. 7.0 days; <i>p</i> = 0.0355), more pain-free days (14.0 vs. 5.0 days; <i>p</i> = 0.0379) and lower HIT-6 scores (59.0 vs. 65.0; <i>p</i> = 0.1584). Readmission rates were lower in the intervention group (9.5% vs. 23.8%) but not statistically significant. Adverse events associated with the GON block were mild and transient, including local pain (47.6%) and minor bleeding (14.3%).ConclusionsGON block as an adjunct to triple therapy is effective and well tolerated for the acute treatment of migraine, providing significant short-term relief and improving outcomes at 30-day follow-up. Our failure to blind the outcome assessors limit the validity of our results, which supports the use of GON block as an adjunct to parenteral therapy for patients with migraine in the emergency department.Trial RegistrationThis study was not registered in a public trial registry.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251381764"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What does ChatGPT know about Migraine? A comparative-descriptive analysis.","authors":"Lucas Bernardi Garcia, Ana Júlia Ferreira, Mohamad Ali Hussein, Pedro André Kowacs","doi":"10.1177/03331024251387684","DOIUrl":"https://doi.org/10.1177/03331024251387684","url":null,"abstract":"<p><p>BackgroundThe integration of artificial intelligence (AI) into medical education and clinical decision-making is rapidly expanding. ChatGPT-4o, a multimodal AI model, offers real-time access to a vast corpus of biomedical knowledge. Nonetheless, concerns persist regarding the scientific accuracy and interpretive reliability of its responses when applied to clinical subjects such as migraine.AimTo assess the reliability and factual accuracy of ChatGPT-4o when addressing key clinical questions regarding migraine.MethodsEight clinically relevant questions were submitted to ChatGPT-4o, covering migraine pathophysiology, diagnosis and treatment. Each response was compared with current evidence from high-impact medical literature and rated as satisfactory, partially satisfactory or unsatisfactory. Classifications were based on conceptual accuracy, reference validity and clinical coherence.ResultsOf the eight responses analyzed, 62.5% were classified as satisfactory, while 37.5% were deemed partially satisfactory. No response was considered entirely unsatisfactory. The most common limitations included reference-related AI hallucinations and insufficient technical depth in selected answers.ConclusionsChatGPT-4o demonstrates potential as a support tool in the dissemination of structured medical information about migraine. However, its clinical use must remain supervised by professionals, given its limitations in bibliographic precision and interpretive nuance.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251387684"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disrupted functional network topology in tension-type headache: A cross-sectional magnetoencephalography study.","authors":"Zhonghua Xiong, Dong Qiu, Jie Liang, Xiaoshuang Li, Zhi Guo, Mantian Zhang, Geyu Liu, Tianshuang Gao, Yonggang Wang","doi":"10.1177/03331024251386425","DOIUrl":"https://doi.org/10.1177/03331024251386425","url":null,"abstract":"<p><p>BackgroundTension-type headache (TTH) is the most common primary headache, yet its neural basis remains unclear. Magnetoencephalography (MEG) combined with graph-theoretical analysis enables precise mapping of functional brain networks. This study aimed to identify network-level connectivity alterations in TTH using resting-state MEG and graph-based metrics.MethodsWe analyzed resting-state MEG data from 27 TTH patients during the interictal period and 37 age- and gender-matched healthy controls, all with eyes closed. Functional connectivity (FC) across 1-45 Hz was mapped and analyzed using graph theory. Network topology metrics were computed, and their associations with clinical symptoms were assessed.ResultsTTH patients showed increased FC across 1-45 Hz, notably between the right somatomotor and frontal operculum and insula (FrOperIns), and between the temporo-occipital-parietal (TempOccPar) and visual regions, with the latter positively correlated with Headache Impact Test-6 scores. Frequency-specific increases were observed between the left prefrontal and right orbitofrontal cortices (delta, theta), somatomotor and FrOperIns (theta), and TempOccPar and visual areas (beta). Graph theory analysis revealed nodal abnormalities, particularly in the left precuneus and posterior cingulate and prefrontal cortices, along with elevated local efficiency and clustering coefficient.ConclusionsThese findings indicate that TTH is associated with frequency-specific alterations in functional connectivity and disrupted network topology, particularly involving regions implicated in pain processing and cognitive control. Graph-theoretical MEG analysis may offer valuable insights into the neural mechanisms of TTH and support the development of network-based biomarkers.<b>Trial Registration:</b> ClinicalTrials.gov Identifier: NCT05334927.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251386425"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of treating migraine attacks early - even in youth: A real-world argument for neuromodulation.","authors":"Mario F P Peres, Hsiangkuo Yuan, Cristina Tassorelli","doi":"10.1177/03331024251370675","DOIUrl":"https://doi.org/10.1177/03331024251370675","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251370675"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research to improve headache classification: Results, methods, and future challenges.","authors":"Jes Olesen","doi":"10.1177/03331024251377753","DOIUrl":"https://doi.org/10.1177/03331024251377753","url":null,"abstract":"<p><p>IntroductionThe international headache classification has been enormously important promoting research and clinical management of patients with headache. It is a living document that develops from edition to edition and changes have been increasingly based on research, so called classification research. The aim of the present review is to present recent results of such research and to characterize the methods available for it.MethodsPublished research was identified by systematic search of PubMed. Lists of references of identified articles and the table of content of the last five years of <i>Cephalalgia</i> were screened.ResultsThe major results of identified articles are summarized. Thereafter the different methodologies applied in these studies are described. Finally, some suggestions are made for the future consideration of the fourth classification committee.ConclusionClassification research is emerging as an important avenue of headache research. It has a multitude of different designs available and many of them do not need advanced equipment.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251377753"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine-related disability according to headache frequency subclassifications: A systematic review and meta-analysis.","authors":"Manjit Singh Matharu, Stephen Silberstein, Hsiangkuo Yuan, Deborah Edgar, Roos Colman, Todd J Schwedt, Michel Lanteri-Minet, Mark Obermann","doi":"10.1177/03331024251385965","DOIUrl":"https://doi.org/10.1177/03331024251385965","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BackgroundThis systematic review and meta-analysis synthesized migraine-related disability outcomes according to headache frequency subclassifications, including low-frequency episodic migraine (LFEM), high-frequency episodic migraine (HFEM) and chronic migraine (CM).MethodsWe searched the PubMed and Cochrane Library (CENTRAL) up to 16 October 2024 for peer-reviewed non-interventional studies reporting migraine-related disability outcomes in CM and subclassifications of episodic migraine (e.g. LFEM and HFEM). Eligible studies with an HFEM subgroup were grouped by headache frequency measure (monthly migraine days [MMD] or monthly headache days [MHD]), HFEM subgroup, disability parameter and study setting. Random-effects meta-analyses were conducted on groups with three or more studies, with the results presented in forest plots. Risk of bias was assessed using Joanna Briggs Institute tools.ResultsOf the 32 included studies, 27 were grouped, yielding five meta-analysis groups containing three or more studies. All five groups had an HFEM subgroup of 8-14 MHD. Accordingly, we classified LFEM as 0-7 MHD and CM as ≥15 MHD. Ten studies contributed data to the five meta-analysis groups. Estimated pooled values are reported by headache frequency subgroup for each meta-analysis group: LFEM (95% confidence interval [CI]), HFEM (95% CI) and CM (95% CI). For meta-analysis group 1, four population-based studies reported Migraine Disability Assessment (MIDAS) Grade IV proportions, with pooled values of 11.1% (7.1-17.1), 43.9% (31.8-56.9) and 57.5% (42.7-71.1), respectively. For meta-analysis group 2, five population-based studies documented Work Productivity and Activity Impairment (WPAI) outcomes. Pooled mean overall work productivity impairment (OWPI) scores were 36.9% (30.8-43.1), 44.7% (38.4-51.0) and 52.0% (47.7-56.3), respectively. Pooled mean activity impairment (AI) scores were 36.4% (33.7-39.1), 46.4% (42.8-50.0) and 53.5% (52.1-54.8), respectively. For meta-analysis group 3, three clinic-based studies presented MIDAS Grade IV proportions. Pooled values were 15.0% (4.4-40.5), 42.4% (17.1-72.4) and 65.7% (30.3-89.4), respectively. For meta-analysis group 4, three clinic-based studies reported WPAI outcomes. Pooled mean OWPI scores were 28.8% (21.6-35.9), 40.2% (36.2-44.2) and 49.6% (46.3-52.9), respectively. Pooled mean AI scores were 29.4% (21.9-36.9), 43.5% (39.0-48.1) and 51.6% (48.8-54.4), respectively. For meta-analysis group 5, three clinic-based studies detailed MIDAS scores. Pooled mean scores were 10.7 (3.9-17.5), 23.9 (9.4-38.4) and 49.6 (15.8-83.3), respectively.ConclusionsThis study showed a pattern of increasing migraine-related disability with rising headache frequency. Regardless of study setting, our meta-analyses also suggested a severe level of disability in many individuals (42%-44%) with HFEM, highlighting an unmet need for more effective migraine management. Disability burden and headache frequency should both be considered wh","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"45 10","pages":"3331024251385965"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}